Percussion Test: No Tenderness, If The Tooth Is Tender This Evaluate Tooth For Luxation Or Root FractureMobility Test: There Is Normal Mobility :

Percussion Test: No Tenderness, If The Tooth Is Tender This Evaluate Tooth For Luxation Or Root FractureMobility Test: There Is Normal Mobility

Sensibility Test: Usually Positive, This Test Is VIP In Assessing The Risk Of Future Healing Complications, Lack Of Response To The Examination Indicates An Increased Risk Of Future Pulp Necrosis . :

Sensibility Test: Usually Positive, This Test Is VIP In Assessing The Risk Of Future Healing Complications, Lack Of Response To The Examination Indicates An Increased Risk Of Future Pulp Necrosis .

Radiographic Examination:Radiographs Recommended Are Periapical,occlusal&eccentric Exposure To Rule Out Displacement,pesence Of Luxation Or Root Fracture. :

Radiographic Examination:Radiographs Recommended Are Periapical,occlusal&eccentric Exposure To Rule Out Displacement,pesence Of Luxation Or Root Fracture.

Slide 9:

In The Radiographic Images The Loss Of Tooth Substance Is Visible.Also Radiographs For Lip&cheek Laceration VIP To Search Tooth Fragments And Foreign Bodies.

Slide 10:

PERIODONTAL CHANGES LOSS OF TOOTH SUBSTANCE

Treatment:Age And Cooperation Of The Patient Influence The Treatment Plan Wether It’s Primary, Mixed, Or Secondary Dentition,Also Location And Extent Of Injury. :

Treatment:Age And Cooperation Of The Patient Influence The Treatment Plan Wether It’s Primary, Mixed, Or Secondary Dentition,Also Location And Extent Of Injury.

Slide 12:

The Aim Of The Treatment:Is To Preserve The Functional State Of Teeth, Bone And Gingiva.

Slide 13:

N.B. The Main Factor In Determining Prognosis After Any Form Of Pulp Exposure Is Minimizing The Bacterial Invasion Of The Pulp.

There Are Four Factors Contribute The Management Of Complicated Crown Fracture:1- The Length Of Time Elapsed Since The Injury Occur.2-the Size Of The Pulp Exposure.3- The Condition Of The Pulp (Vital Or Non Vital).4- Stage Of Root Development. :

There Are Four Factors Contribute The Management Of Complicated Crown Fracture:1- The Length Of Time Elapsed Since The Injury Occur.2-the Size Of The Pulp Exposure.3- The Condition Of The Pulp (Vital Or Non Vital).4- Stage Of Root Development.

Complicated Crown Fracture With Vital Pulp :

Complicated Crown Fracture With Vital Pulp Tooth With Open Apex:
The Prognosis Is Best If The Fracture Is Treated Within The First Two Hours.
Direct Pulp Capping Is Indicated For Small Pin Point Exposure Occurring At Pulp Horn And Not An Axial Pulpal Line Angle.

Slide 16:

If The Tooth With Open Apex And Small Pulp Exposure (1- 1.5 Mm) And Seen Within 24 Hours Its Directly Pulp Capped With Calcium Hydroxide.
If The Exposure Is Larger Or Small Over 24 Hours , Calcium Hydroxide Pulpotomy Is Needed.

This Procedure Has Very High Success Rate And It’s Designed To Allow Tooth With Open Apex To Complete Root Development. :

This Procedure Has Very High Success Rate And It’s Designed To Allow Tooth With Open Apex To Complete Root Development.

Slide 18:

Tooth With Closed Apex:Direct Pulp Cap Should Be Performed With Small Exposure , And Patient Seen Within 24 Hours. If The Exposure Is Larger Than 1.5 Mm, Or Time Elapsed Is Larger Than 24 Hours, Root Canal Treatment Is Performed.

Follow Up: By Clinical And Radiographic Controls After 6-8 Weeks And 1 Year. Fragment removal Clean with water Allow G. to reattach to exposed to dentin Disinfect with sodium hypochloride apply GI. or composite cements to exposed dentine Restore with composite

2-fragment Removal With Gingivectomy :

2-fragment Removal With Gingivectomy Removal Of Segment Of The Fractured Fragment With Subsequent Endodontic Treatment And Restoration With A Post-retained Crown. This Procedure Should Be Preceded By A Gingivectomy And Sometimes Ostectomy With Osteoplasty.
Indication: Fractures Where Denudation Of The Fracture Site Does Not Compromise Esthetics (I.E. Fractures With Palatal Extension).
Advantages: Relatively Easy Procedure. Restoration Can Be Completed Soon After Injury.
Disadvantages: The Restored Tooth May Migrate Labially Due To formation of a pseudo-pocket palatally.

3- Orthodontic Extrusion Of Apical Fragment :

3- Orthodontic Extrusion Of Apical Fragment Removal Of The Segment Of The Fractured Fragment With Subsequent Endodontic Treatment And Orthodontic Extrusion Of The Remaining Root With Sufficient Length After Extrusion To Support A Post-retained Crown.
Indication: All Types Of Fractures, Assuming That Reasonable Root Length Can Be Achieved After Extrusion.
Advantages: Stable Position Of The Restored Tooth. Optimal Gingival Health.
Disadvantages: Time Consuming Procedure With Late Completion Of final restoration.

4-surgical Extrusion :

4-surgical Extrusion Removal Of The Fractured Fragment With Subsequent Repositioning Of The Root In A More Coronal Position.
Indication: All Types Of Fractures (Except Crown-root Fractures In Young Teeth With Open Apices Where Vitality Should Be Preserved) Assuming That Reasonable Root Length Can Be Achieved.
Advantages: Rapid Procedure.
Stable Position Of The Tooth.
The Method Allows Inspection Of The Root For Additional Fracture.
Disadvantages: Limited Risk For Root Resorption And Marginal Breakdown Of The Periodontium.

5-decoronation :

5-decoronation An Implant Solution Is Planned, The Root Fragment May Be Left In Situ After Coronectomy In Order To Avoid Alveolar Resorption Maintaining The Volume Of The Alveolar Process For Later Optimal Implant Installation.
Indication: Can Be Used In Cases Where The Root Cannot Support A Post-retained Crown Restoration.
Advantages: Preserves The Alveolar Process.
Disadvantages: Postpones Definitive Restoration.